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中华老年骨科与康复电子杂志

中华老年骨科与康复电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 79 -84. doi: 10.3877/cma.j.issn.2096-0263.2021.02.003

所属专题： 文献；

骨与创伤

内侧开放楔形胫骨高位截骨术后隐性失血及其危险因素分析
徐奎帅1, 张靓2, 陈进利1, 张益1, 戚超1, 李海峰1, 高甲科1, 陈伯华1, 于腾波1,†()   
  1. 1. 266000　青岛大学附属医院骨科中心
    2. 266000　青岛大学附属医院腹部超声科
  • 收稿日期:2020-10-15 出版日期:2021-04-05
  • 通信作者: 于腾波
  • 基金资助:
    国家自然科学基金面上项目(31872310)

Analysis of recessive blood loss and risk factors after medial open wedge high tibial osteotomy

Kuishuai Xu1, Liang Zhang2, Jinli Chen1, Yi Zhang1, Chao Qi1, Haifeng Li1, Jiake Gao1, Bohua Chen1, Tengbo Yu1,†()   

  1. 1. Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao 266000, China
    2. Department of Abdominal ultrasound, Affiliated Hospital of Qingdao University, Qingdao 266000, China
  • Received:2020-10-15 Published:2021-04-05
  • Corresponding author: Tengbo Yu
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引用本文：

徐奎帅, 张靓, 陈进利, 张益, 戚超, 李海峰, 高甲科, 陈伯华, 于腾波. 内侧开放楔形胫骨高位截骨术后隐性失血及其危险因素分析[J]. 中华老年骨科与康复电子杂志, 2021, 07(02): 79-84.

Kuishuai Xu, Liang Zhang, Jinli Chen, Yi Zhang, Chao Qi, Haifeng Li, Jiake Gao, Bohua Chen, Tengbo Yu. Analysis of recessive blood loss and risk factors after medial open wedge high tibial osteotomy[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(02): 79-84.

目的

探讨内侧开放楔形胫骨高位截骨术（OWHTO）治疗膝骨性关节炎围手术期隐性失血（HBL）情况及其可能的危险因素。

方法

回顾性选取2017年8月至2019年10月行OWHTO治疗的膝骨性关节炎患者96例，其中男34例，女62例；年龄48~66岁，平均（58±5）岁。围手术期HBL根据Gross公式计算。根据术后HBL情况，将所有患者分为低隐性失血组（n=75），高隐性失血组（n=21），分析比较两组患者一般资料、基础疾病、影像学测量指标，采用多因素线性回归分析影响围手术期HBL发生的危险因素，并利用受试者工作特征曲线计算相关资料对OWHTO术后高隐性失血的预测价值。

结果

多因素Logistic回归分析结果显示，手术时间（OR=1.057，95% CI：1.009，1.106，P=0.018）、身体质量指数（BMI）（OR=1.298，95% CI：1.043，1.614，P=0.019）、高血压（OR=4.819，95% CI：1.445，16.071，P=0.011）和髋-膝-踝角（HKA）（OR=1.230，95% CI：1.036，1.459，P=0.018）是OWHTO术后高隐性失血的独立危险因素，差异均有统计学意义。受试者工作特征曲线表明，手术时间、BMI、高血压和HKA对OWHTO术后高隐性失血均有较好的预测价值，曲线下面积分别为0.684，0.690，0.635，0.708。

结论

手术时间、BMI、高血压和HKA是影响OWHTO术后高HBL的独立危险因素，针对肥胖、高血压、内翻畸形严重的患者，及应早采取干预措施，缩短手术时间，对减少术后高HBL具有重要意义。

关键词: 内侧开放楔形胫骨高位截骨术, 隐性失血, 危险因素, 统计学
Objective

To investigate the Opening wedge High tibial osteotomy (OWHTO) for treating Hidden blood loss (HBL) of knee osteoarthritis during the perioperative period and to analyze its possible risk factors. All of the data were presented by PRESENTING all of the data.

Methods

A total of 96 patients with knee osteoarthritis treated by OWHTO from August 2017 to October 2019 were selected, including 34 males and 62 females. The average age was (58±5) between 48 and 66 years old. Perioperative HBL was calculated according to Gross formula. According to HBL following surgery, all patients were divided into low recessive bleeding group (n=75), high recessive bleeding group (n=21), compared two groups of patients with general information, basic diseases, imaging measurement indicators, the multifactor linear regression analysis risk factors that affect the perioperative HBL and the receiver-operating characteristic curve is used to calculate the related data of OWHTO postoperative high predictive value of the recessive loss of blood.

Results

Multivariate Logistic regression analysis showed that operation time (OR=1.057, 95% CI: 1.009, 1.106, P=0.018), BMI (OR=1.298, 95% CI: 1.043, 1.614, P=0.019), hypertension (OR=4.819, 95% CI: 1.445, 16.071, P=0.011) and HKA (OR=1.230, 95%CI: 1.036, 1.459, P=0.018) was an independent risk factor for high latent blood loss after OWHTO surgery, and the difference was statistically significant. The operating characteristic curves of the subjects showed that the operative time, BMI, hypertension and HKA all had good predictive value for high latent blood loss after OWHTO operation, and the area under the curves were 0.684, 0.690, 0.635 and 0.708, respectively.

Conclusion

Operation time, BMI, hypertension and HKA are independent risk factors for high HBL after OWHTO. For patients with obesity, hypertension and severe varus deformity, early intervention measures should be taken to shorten the operation time, which is of great significance for reducing high HBL after OWHTO.

Key words: Open-wedge high tibial osteotomy, Hidden blood loss, Risk factors, Statistics
表1 两组膝骨性关节炎患者术前一般资料
组别 例数 年龄（岁，±s） 性别（例，男/女） 体质指数（Kg/m2，±s） 吸烟（例） 饮酒（例） 病程（年，±s） 侧别（例，左/右） 手术时间（min，±s）
高隐性失血组 21 59±5 12/9 28.7±2.5 5/16 6/15 5.8±1.9 7/14 81.3±13.9
低隐性失血组 75 58±5 22/53 27.0±2.7 12/63 19/56 5.6±2.1 16/59 90.2±1.4
t值或χ2值   -0.847 1.372 -2.484 0.687 0.089 -0.411 1.297 -2.701
P值   0.399 0.420 0.015 0.407 0.765 0.682 0.255 0.008
表2 两组膝骨性关节炎患者术前影像学指标比较（±s）
组别 例数 HKA（°） LDFA（°） MPTA（°） 截骨间隙（mm）
高隐性失血组 21 8.8±2.6 87.7±1.9 84.6±2.4 10.4±2.8
低隐性失血组 75 6.6±3.7 88.0±1.9 85.6±3.0 9.6±2.8
t值   -2.626 -0.600 1.258 -1.131
P值   0.010 0.550 0.212 0.261
表3 两组膝骨性关节炎患者合并症情况比较（例）
组别 例数 高血压 糖尿病 冠心病 脑血管疾病
高隐性失血组 21 11 5 3 1
低隐性失血组 75 19 14 9 3
χ2值   5.587 0.273 0.078 0.024
P值   0.018 0.601 0.780 0.877
表4 两组膝骨性关节炎患者术前血常规指标比较（±s）
组别 例数 红细胞（g/L） 红细胞压积（%） 白细胞（×109L-1） 血沉（mm/h） C反应蛋白（mg/L） 血小板（×109L-1） 白蛋白（g/L）
高隐性失血组 21 140.43±9.10 41.45±2.69 5.23±1.61 9.33±5.86 12.16±18.47 203.76±4.49 35.10±2.32
低隐性失血组 75 139.09±9.97 41.18±2.80 4.97±1.25 11.15±8.26 21.53±20.02 216.56±29.56 36.23±2.77
t值   -0.552 -0.594 0.232 0.588 0.100 0.042 0.093
P值   0.582 0.693 0.444 0.349 0.057 0.066 0.091
表5 Logistic回归分析高隐性失血相关危险因素
项目 回归系数 标准误差 瓦尔德 OR值 95%可信区间 P值
BMI 0.261 0.111 5.480 1.298 1.043，1.298 0.019
高血压 1.572 0.615 6.546 4.819 1.455，16.071 0.011
手术时间 0.055 0.023 5.564 1.057 1.009，1.106 0.018
HKA 0.207 0.087 5.605 1.230 1.036，1.459 0.018
图1 手术时间、HKA、BMI及高血压预测OWHTO术后高HBL的受试者工作特征曲线
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